Blakely William F, Port Matthias, Abend Michael
Scientific Research Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America.
Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Munich, Germany.
J Radiol Prot. 2021 Dec 6;41(4). doi: 10.1088/1361-6498/ac15df.
The accepted generic multiple-parameter and early-response biodosimetry and dosimetry assessment approach for suspected high-dose radiation (i.e. life-threatening) exposure includes measuring radioactivity associated with the exposed individual (if appropriate); observing and recording prodromal signs/symptoms; obtaining serial complete blood counts with white-blood-cell differential; sampling blood for the chromosome-aberration cytogenetic bioassay using the 'gold standard' dicentric assay (premature chromosome condensation assay for exposures >5 Gy photon acute doses equivalent), measurement of proteomic biomarkers and gene expression assays for dose assessment; bioassay sampling, if appropriate, to determine radioactive internal contamination; physical dose reconstruction, and using other available opportunistic dosimetry approaches. Biodosimetry and dosimetry resources are identified and should be setup in advance along with agreements to access additional national, regional, and international resources. This multifaceted capability needs to be integrated into a biodosimetry/dosimetry 'concept of operations' for use in a radiological emergency. The combined use of traditional biological-, clinical-, and physical-dosimetry should be use in an integrated approach to provide: (a) early-phase diagnostics to guide the development of initial medical-management strategy, and (b) intermediate and definitive assessment of radiation dose and injury. Use of early-phase (a) clinical signs and symptoms, (b) blood chemistry biomarkers, and (c) triage cytogenetics shows diagnostic utility to predict acute radiation injury severity.
对于疑似高剂量辐射（即危及生命）暴露，公认的通用多参数和早期反应生物剂量测定及剂量测定评估方法包括：测量与受照个体相关的放射性（如适用）；观察和记录前驱症状；进行连续全血细胞计数及白细胞分类；采集血液进行染色体畸变细胞遗传学生物测定，采用“金标准”双着丝粒测定法（对于大于5 Gy光子急性剂量当量的暴露采用早熟染色体凝聚测定法），测量蛋白质组学生物标志物并进行基因表达测定以评估剂量；如有必要，进行生物测定采样以确定放射性体内污染；进行物理剂量重建，并采用其他可用的机会性剂量测定方法。应确定生物剂量测定和剂量测定资源，并应提前建立这些资源，同时达成获取其他国家、区域和国际资源的协议。这种多方面的能力需要整合到生物剂量测定/剂量测定“操作概念”中，以用于放射应急情况。应采用综合方法联合使用传统的生物、临床和物理剂量测定，以提供：(a)早期诊断，以指导制定初始医疗管理策略，以及(b)对辐射剂量和损伤进行中期和最终评估。使用早期(a)临床症状和体征、(b)血液化学生物标志物以及(c)分类细胞遗传学显示出预测急性辐射损伤严重程度的诊断效用。
